腔镜下经口腔前庭与经胸前入路治疗分化型甲状腺癌临床疗效的Meta分析

The clinical efficacy of endoscopic thyroidectomy via oral vestibular approach versus anterior chest approach for differentiated thyroid carcinoma:a meta-analysis

目的:比较腔镜下经口腔前庭与经胸前入路甲状腺切除术治疗分化型甲状腺癌的临床疗效。方法:通过计算机检索中英文数据库中两种术式治疗分化型甲状腺癌疗效的相关文献,纳入文献时间为建库至2021年9月。提取文献内数据,使用RevMan 5.4软件进行Meta分析。结果:最终纳入回顾性研究文献7篇,共689例患者,其中经口腔前庭组328例,经胸前入路组361例。Meta分析结果显示,相较经胸前入路组,经口腔前庭组术中出血量更少[WMD=-1.62,95%CI(-2.70,-0.54),P=0.003],术后引流量更少[WMD=-9.85,95%CI(-17.82,-1.88),P=0.02],中央区淋巴结清扫数量更多[WMD=1.08,95%CI(0.07,2.08),P=0.04],差异有统计学意义。两种术式在手术时间[WMD=-0.95,95%CI(-2.79,0.9),P=0.31]、住院时间[WMD=0.41,95%CI(-0.59,1.41),P=0.42]、术后感染[OR=2.94,95%CI(0.56,15.49),P=0.20]、术后手足麻木(甲状旁腺损伤)[OR=0.59,95%CI(0.14,2.43),P=0.46]、术后饮水呛咳(喉上神经损伤)[OR=5.22,95%CI(0.87,31.23),P=0.07]、术后喉返神经损伤[OR=0.47,95%CI(0.09,2.65),P=0.40]方面差异无统计学意义(P>0.05)。结论:腔镜下经口腔前庭与经胸前入路甲状腺手术均具有安全、可靠的临床疗效,经口腔前庭入路在术中出血、术后引流及中央区淋巴结清扫方面更具优势,对于追求无瘢痕手术的患者可优先考虑。

Objective:To compare the clinical efficacy of endoscopic thyroidectomy via oral vestibular approach and anterior chest approach in the treatment of differentiated thyroid carcinoma.Methods:By searching Chinese and English databases from the establishment of the database to Sep.2021,all literatures comparing endoscopic thyroidectomy via oral vestibular approach and anterior chest approach for differentiated thyroid carcinoma were collected.Relevant data and materials were extracted.Then,RevMan 5.4 software was used for meta-analysis.Results:Seven retrospective studies involving 689 patients were finally included,of whom 328 in oral vestibular approach group and 361 in anterior chest approach group.Meta-analysis results showed:compared with the anterior chest approach group,the oral vestibular approach group had advantages of fewer intraoperative blood loss[WMD=-1.62,95%CI(-2.70,-0.54),P=0.003],less postoperative drainage volume[WMD=-9.85,95%CI(-17.82,-1.88),P=0.02]and more lymph node dissected in the central area[WMD=1.08,95%CI(0.07,2.08),P=0.04],the differences were statistically significant(P<0.05).There were no statistically significant differences in operative time[WMD=-0.95,95%CI(-2.79,0.9),P=0.31]and hospital stay[WMD=0.41,95%CI(-0.59,1.41),P=0.42].And the incidence of postoperative infection[OR=2.94,95%CI(0.56,15.49),P=0.20],postoperative hands and feet numbness(parathyroid injury)[OR=0.59,95%CI(0.14,2.43),P=0.46],postoperative bucking(superior laryngeal nerve injury)[OR=5.22,95%CI(0.87,31.23),P=0.07]and postoperative recurrent laryngeal nerve injury[OR=0.47,95%CI(0.09,2.65),P=0.40]were not significantly different between the two groups(P>0.05).Conclusions:The results of the two surgical approaches are similar in terms of clinical effectiveness and safety.And the oral vestibular approach has the advantages in the aspects of intraoperative blood loss,postoperative drainage and the number of lymph node dissected in the central area.Thus the oral vestibular approach is the better option for patients seeking scar-free.